One Running Shoe in the Grave

New Studies on Older Endurance Athletes Suggest the Fittest Reap Few Health Benefits

ENLARGE

Athletes compete in the World Triathlon Grand Final in Auckland, New Zealand, on Oct. 21.
Associated Press

By

Kevin Helliker

Nov. 27, 2012 8:02 p.m. ET

In a five-kilometer race Thanksgiving morning, Ralph Foiles finished first in his age group, earning the 56-year-old Kansan a winner's medal.

Or was it a booby prize?

A fast-emerging body of scientific evidence points to a conclusion that's unsettling, to say the least, for a lot of older athletes: Running can take a toll on the heart that essentially eliminates the benefits of exercise.

"Running too fast, too far and for too many years may speed one's progress toward the finish line of life," concludes an editorial to be published next month in the British journal Heart.

Until recently, the cardiac risk of exercise was measured almost exclusively by the incidence of deaths during races. For marathoners, that rate was one in 100,000—a number that didn't exactly strike fear. Moreover, data showed that runners generally enjoyed enormous longevity benefits over nonrunners.

What the new research suggests is that the benefits of running may come to a hard stop later in life. In a study involving 52,600 people followed for three decades, the runners in the group had a 19% lower death rate than nonrunners, according to the Heart editorial. But among the running cohort, those who ran a lot—more than 20 to 25 miles a week—lost that mortality advantage.

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Meanwhile, according to the Heart editorial, another large study found no mortality benefit for those who ran faster than 8 miles per hour, while those who ran slower reaped significant mortality benefits.

Those two studies—presented at recent medical conferences—follow the publication in recent months and years of several other articles finding cardiac abnormalities in extreme athletes, including coronary artery calcification of a degree typically found in the utterly sedentary.

ENLARGE

Meghan Newcomer is a 32-year-old professional triathlete who has passed out during several races in recent years.
Joseph Battaglia

Opinion is nearly unanimous among cardiologists that endurance athletics significantly increases the risk of atrial fibrillation, an arrhythmia that is estimated to be the cause of one third of all strokes. "Chronic extreme exercise appears to cause excessive 'wear-and-tear' on the heart," the editorial says.

Not everyone is lining up behind the new data. "The guys advancing the hypothesis that you can get too much exercise are manipulating the data," said Paul Thompson, a former elite marathoner and nationally renowned sports cardiologist at Hartford Hospital. "They have an agenda."

Sports cardiologist James O'Keefe, an author of the Heart paper, counters that Dr. Thompson is an exercise addict. "He, like many chronic exercise addicts, is the one with an agenda," said Dr. O'Keefe, a sports cardiologist at Saint Luke's Mid America Heart Institute in Kansas City. "My 'agenda' is my patients."

Critics of the newer research say that the idea that running can harm the heart is based on research showing only an association—meaning that exercise may not be the cause of the problem. The note that in any large group of runners, high-mileage and high-speed athletes may be too few in number to be statistically significant.

Yet by all accounts, dosage is no less relevant to exercise than to any other medical treatment, and for years the endurance-athletics movement has prompted words of caution from none other than Kenneth Cooper, the Dallas physician widely credited with launching the aerobics movement nearly half a century ago. "If you are running more than 15 miles a week, you are doing it for some reason other than health," said Dr. Cooper, adding that he suspects—without hard evidence—that extreme exercise can render a body more susceptible to cancer.

The most vocal proponent of cutting back for cardiac reasons is Dr. O'Keefe, a 56-year-old cardiologist and former elite athlete. From 1999 to 2004, he won outright the largest sprint distance triathlon in Kansas City, a testament not only to his athletic abilities but also to hours and hours of early- and late-hour training.

But a sense that this regimen was aging him prematurely, coupled with the mounting awareness of cardiac issues in extreme endurance athletes, prompted Dr. O'Keefe to slash his running to below 20 miles a week, never faster than eight minutes a mile.

Asked if he ever runs a five-kilometer race for time, he said, "Not for the past three years. After age 50, pushing too hard is probably not good for one's heart or longevity."

Meanwhile, Dr. O'Keefe's fellow author on the upcoming Heart paper, Carl Lavie, continues racing at speeds slightly above what their editorial recommends. "I did a turkey day five-mile race in 38 minutes," said Dr. Lavie, a cardiologist at the John Ochsner Heart and Vascular Institute in New Orleans. "I train slower than I race, and when I race I know the risks. That's all we're trying to do: Let people know the risks and make up their own minds."

The conflict between pursuit of health and of athletic glory is particularly acute in Meghan Newcomer, a 32-year-old professional triathlete who in recent years passed out during several races, requiring acute medical attention and prompting her loved ones to ask her to slow down or retire. She has a promising medical career, after all: Why not quit competing?

Instead, after undergoing in-depth study at a Connecticut sports-medical clinic, she was told to triple her intake of sodium during races. Yet she was also told to slow down, advice that helped her this summer complete—without passing out—her first Ironman-distance triathlon.

The idea that serial marathoners may earn no cardiac advantage over couch potatoes will surely amuse serial viewers of "Seinfeld" reruns. But don't expect the running boom to grind to a halt. Optimal health isn't necessarily the Holy Grail, even for aging athletes.

"Even if I knew for sure that running fast had an element of risk, I don't know that I would back down," said Foiles, the 56-year-old runner who lives in a Kansas City suburb. "To finish at the front of my age group, yeah, that's an inspiration."

I find this all very interesting, having just gone through my first, and hopefully last bout of atrial fibulation. I am 57 years old and have been exercising pretty hard since college. Although not an "endurance athlete," I am an avid cross country citizen racer and raced both road and trail right up until this summer, when I suddenly noticed I was "losing it" on runs in the hills. No aerobic capacity, and an overall bonking feeling. I really became alarmed when I could not even check my pulse, it was so erratic. After a month I decide to see the doctor and the diagnosis was a-fib, something I had never even heard of. So, after doing lots of research, I find all of this very interesting to say the least. There does appear to be some correlation between sustained endurance exercise and increasing chance of a-fib, if the research is to be believed. Two weeks ago I had a successful cardio-version and am continuing to take Pradaxa twice a day. My exercise program is now hiking with my Welsh terrier and throwing in occasional jogs. I am hoping to get back to trail running, but have been somewhat leery. Would not mind hearing from others who have had a similar experience.

Physical activity reduces many major mortality risk factors including arterial hypertension, diabetes mellitus type 2, dyslipidemia, coronary heart disease, stroke, and cancer. All-cause mortality is decreased by about 30% to 35% in physically active as compared to inactive subjects. The purpose of this paper was to synthesize the literature on life expectancy in relation to physical activity. A systematic PubMed search on life expectancy in physically active and inactive individuals was performed. In addition, articles comparing life expectancy of athletes compared to that of nonathletes were reviewed. Results of 13 studies describing eight different cohorts suggest that regular physical activity is associated with an increase of life expectancy by 0.4 to 6.9 years. Eleven studies included confounding risk factors for mortality and revealed an increase in life expectancy by 0.4 to 4.2 years with regular physical activity. Eleven case control studies on life expectancy in former athletes revealed consistently greater life expectancy in aerobic endurance athletes but inconsistent results for other athletes. None of these studies considered confounding risk factors for mortality. In conclusion, while regular physical activity increases life expectancy, it remains unclear if high-intensity sports activities further increase life expectancy.

I have been a runner on and off since I ran in college over 45 years ago. In recent years I have given up long distance running to concentrate on strength training and high intensity interval workouts because the science has shown us that this is the best way for us old folks to exercise. I appreciate your article but it it is really old news.

A daily routine of physical activity is highly beneficial in the prevention and treatment of many prevalent chronic diseases, especially of the cardiovascular (CV) system. However, chronic, excessive sustained endurance exercise may cause adverse structural remodeling of the heart and large arteries. An evolving body of data indicates that chronically training for and participating in extreme endurance competitions such as marathons, ultra-marathons, Iron-man distance triathlons, very long distance bicycle racing, etc., can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which generally return to normal within seven to ten days. In veteran extreme endurance athletes, this recurrent myocardial injury and repair may eventually result in patchy myocardial fibrosis, particularly in the atria, interventricular septum and right ventricle, potentially creating a substrate for atrial and ventricular arrhythmias. Furthermore, chronic, excessive, sustained, high-intensity endurance exercise may be associated with diastolic dysfunction, large-artery wall stiffening and coronary artery calcification. Not all veteran extreme endurance athletes develop pathological remodeling, and indeed lifelong exercisers generally have low mortality rates and excellent functional capacity. The aim of this review is to discuss the emerging understanding of the cardiac pathophysiology of extreme endurance exercise, and make suggestions about healthier fitness patterns for promoting optimal CV health and longevity.

I have been running since 1971 and have probably run over 60,000 miles. Am I going to stop? No Way!! Will I be more cognizant of the how much I run? Sure. I think it goes without saying that folks who exercise seriously and have a decent diet are far and away better equipped to deal with aging than their sedentary peers. So keep on running!!!

Lee--The science supports strength training and high intensity interval work as we age rather than slogging out the miles. Yes, a healthy diet is important but long distance running can counter many of the benefits of a healthy diet. The key to life if learning along the way.

Doesn't this article call the definition of fitness into question? The points only cast doubt to the true fitness value of endurance exercise, not fitness itself. And diet isn't even mentioned. I would argue that the data is skewed by the unfit who also happen to be able to run fast and long distances through their pursuits.

Human's evolved as runners. It's what we do. It's good for us. Sometimes, we need to run a long way slowly mixed with walking. Sometimes, we need to run like hell for a short distance.

But I don't think primitive man ran on some crazy 75 miles a week schedule with speedwork on Tuesdays. Also, primitive man didn't sit in front of his terminal all day. He kept running even if he got old.

Also, primitive man ran barefoot. Shoes are nice for protection or style, but padding and orthopedic shoes have caused far more problems than they have fixed.

... I read a study last year...I think in the WSJ... that said that a person's time in the mile is perhaps the best predictor of his/her cardiovascular risk. Those that complete the mile in under 8 min, have the lowest risk and it goes up from there. Old people can't run that fast and they obviously have higher risk. The researchers liked the mile because it combines endurance and maximum output. That study seems to contradict this one but not when you realize the difference. This study is concerned with extreme exercise. The "mile time as a CVD predictor" study measured the masses and clearly found that being light and fast was a good thing. It found no real difference between someone who could run a 5 min mile vs a 8 min mile but a huge difference in heart disease between the 8 min milers and the 14 min milers.

.... Many runners set finishing a marathon as a goal. This is crazy. I ran one once when I was young and it darn near killed me. Now, I rarely run more than an hour. Isn't that enough for health?

... HIT training, or High Intensity Training, has shown many benefits such as higher metabolism, higher testosterone, greater strength and greater gains in shorter time. This involves short intervals of intense running (or other aerobic), followed by a walk or jog and then more intervals. Are the benefits outweighed by cardio risks ?

Vilhelm - I think we mostly agree despite my post above. Not that my opinion matters in the whole scheme of things, but I think your general attitude towards running (and life) is pretty healthy.:)

I will quibble with the whole "we're born to run" statement. It may or may not be true. I've gotten to the point however, where the only time I hear it anymore is from people trying to justify their odd habit of training to run 26 miles in a row or longer. It's possible that the average human could maximize their health benefits by walking/hiking a great deal and then sprinting every once in while. From a calorie output standpoint, it makes much more sense to walk long distances and close the final gap with sprinting. I really can't imagine a scenario in the wild where you'd be running much more than 1 mile. Either you've been eaten or lost track of the prey then then. Humans in various places do run long distances for fun, but that is not universal from what we know of human anthropology.

Primitive man only lived about 30 years, too. So I try not to get too carried away with my primitive self.

Your body talks. It's best to listen. Nobody, even Kenyans, ever got to mile 20 without their body screaming to quit. Twenty miles is enough for a week for me. Never again in a day.

My only personal question is one of intensity. I like to exercise to brief, intense heart rates. Is this a bad idea for an old dude like me? The article seems to say yes. But doing so has made me much more fit without spending all day working out.

@Vilhelm - The "average" paleo man was indeed 30 years old. Unfortunately, that only tells us that lots of babies died. (A 0 year plus a 60 year old divided by 2 is 30 years). It does not tell us how long that man might have lived if they made it to 20, avoided trauma (no hospitals), and had adequate food supplies.

Go with what your body says. I interpreted this article as begin about ultra endurance athletes who tend to get held up as "the fittest". Exercising all day long at best is ineffective and as the article implies, at worst wears the body down.

Having done over 15 marathons with 3:20 PR (NYC is definitely my favorite), I completely agree with the empirical findings, associations, whatever you want to call it. There are significant benefits - including stress management - to exercise, and running in particular. While I value what I gained through competitive running, I also believe it does more harm in the long run - overuse injuries, loss of strength, definite loss of flexibility, low back pain and neuromas in both feet. Loved my running years, but have moved on to core strength conditioning - repairing my health! - through yoga and pilates.

Jill - Good for you! I've "lost" a friend for the moment to serial marathoning. There's nothing wrong with running as part of overall fitness. There are serious health risks, however, with taking up competitive endurance sports as a lifelong hobby. Enjoy getting your health back!! :)

I have been working out 6 days a week for 45 years. I do 155 crunches a day, 40 minutes of cardio and weights. I would not dream of stopping. The benefits for and to me far outweigh how I would feel if I did not work out. Over the years I have run 7 marathons and have skied two world loppets. I would rather go "out" on my last big workout sweating than eating popcorn watching my flat-panel. But, thanks for the article. Gives us something to think about. What I dont get is that my bodymass is actually 29.9%.

The attached article is more consitent with all that I have seen on the topic (I am a multiple marathoner per year still PR'ing at age 48). I have asked my doctor if I am hurting myself & he doesn't seem too concerned... yet.

I wonder if anyone has had this experience. A lifelong runner, as I have aged (now 72) I have slowed down. I can still do the distance, but not at the earlier pace. But here's the thing: Another thing that has accompanied ageing is tinnitus--ringing in the ears.

The strange thing is that I can control tinnitus by running. As a result of running, the sound level seems to be reduced, and the perceived sound doesn't have the debilitating effect that it otherwise has. All this is as a result of running. Within 24 hours of a longish run--say, 10K, the sound begins to come back, so I have to do it all over again. Kind of an enforced health regimen, but I'm glad I discovered this little trick.

Clyde, I have run all my life and had tinnitus all my life (I'm almost positive I got the tinnitus very young from a gun shooting incident). I have never heard of people getting tinnitus from running, or running mitigating the symptoms. But what you say about tinnitus coming with age may be true.

In honor of this article, I bought a new pair of running shoes. And now I can stop feeling bad about being slow and sometimes a slacker, (despite my efforts to the contrary). Running adds a lot to my life, and my knees feel just fine. Posted by Mrs. Thomas

How many times have I read a newspaper article regarding a published study that makes it seems the verdict is in. Eat all the carbs you want but cut fat out of your diet and you will be healthy, lose weight, and lower your chance of heart disease. Now we read that some fat is good and carbs are bad.An individual needs to take responsibility for their health. One needs to test what is good for them.I have been running for 35 years, have run 25 marathons and running has been one of the most enjoyable contributions to my life. Why would I stop? In 10 or 20 or more years these studies may be reversed. We each may react differently to food and exercise.

No one is telling you to stop. The story simply says that some runners at the fanatical end of the spectrum may be overdoing it, and they may want to dial it back a bit. Their heart may not be as robust as they assume. Find study co-author O'Keefe's own comment and linked video a page or 2 back. Quite interesting.

No worries, I won't stop running and I don't put much weight in this study and this article. That was my point .Also, at 64 I can't run an 8 minute mile for more than a mile, but I will continue to run more that 20 miles per week as long as i enjoy it and still can.

Let's see the numbers. The writer gives vague references. Also, let's examine their diets. It's well known that a plant-based diet (no animal protein) coupled with exercise yields a long and productive life. Jim Fixx proved that running marathons could not counteract his diet of cheeseburgers. He dropped dead while running.

True about Jim Fixx and congenital problem. Also, he was one person so he is statistically insignificant. Not so true about the plant-based diet. When you adjust for other factors, vegetarian diet doesn't add lifespan. Vegetarians tend to be skinnier, high educated, and exercise more. Studies that adjust for that show inconclusive results.

Vilhelm - I agree with the plant based diet not being "proven" to expand lifespan. We are omnivores and almost across the board absorb animal based nutrients better than plant based ones. Having eaten a vegatarian diet at one point, I'm not sure the extra years would be worth it anyway.

Also, I'd be interested in the studies showing vegetarianism being thinner - I've known many vegetarian women and they tend to be heavier than normal. Only 2 I can think of have a normal weight and I suspect it's because they avoid any food that would be vaguely enjoyable. The men I've known tend to be thinner, but they also tend to have very little muscle mass.

As a heart rhythm doctor and a bike racer, the steady stream of seemingly super-healthy endurance athletes that populate my practice piques my interest. Why is it that someone so fit and so strong could develop the same diseases that sedentary overweight smokers get? Why is that heart CT scans of marathon runners look like those of smokers? Why is that Born-to-Run types suffer sudden death unexpectedly early? How do we ignore the multitude of studies on long-term endurance exercisers that show (otherwise unexpected) cardiac scars? It's well known that scar in the heart predisposes to electrical abnormalities.

Here's the problem for cardiologists: the overwhelming majority of the disease we see occurs in large part because of inadequate exercise. Most should exercise more. But like everything in life, too much of something is....well...too much.

Thanks for your post. Have been and still do some pretty good bike rides every day. It seems to me that logic would dictate how much exercise or more specifically how fast or hard you train is a matter of common sense. What this article is telling everyone is use your common sense every day in every way and live a long life. Push the envelope and turn off your judgement and pay the price.

Seeing the same disease in both couch potatoes and super endurance marathoners is not really a mystery if you accept insulin resistance as a cause of heart disease. Couch potatoes consume too many carbohydrates without using up the glucose through exercise that would prevent damage associated with insulin resistance. Unfortunately, super endurance marathoner are forced to consume many more carbohydrates then their system can reasonably handle as well despite using most of it up. We are not machines - we cannot endless process extreme amounts of fuel (and a non-preferred type as well.)

Insulin resistance explains why marathoners are more prone to heart attacks, viseral fat, and occasionally they cannot lose those last 20 pounds either. The absolute bottom line is we are not machines - too much exercise is just as damaging as too little.

But to be dark and pessimistic, I would imagine the perfectly reasonable answer I just gave about the subject will still be ignored because mainstream medicine really can't accept that too much dietary sugar and starch (even the mythical good carbs) could be the root cause of many Western circulatory issues. They are getting better but posts by learned Docs make me wonder how exactly we got this far in medicine.

I *love* this story! I've been running for 35 years and my knees are fine because I wouldn't dream of running on concrete. (I cringe when I see the neighborhood school's cross-country team racing on the sidewalk, poor things.) I've never been a fast runner but now I've slowed down to the point where strangers actually stop me to compliment me on how fast I *walk*! It's embarrassing when I occasionally "race", but I guess I'm doing the right thing. (I never get sick, either, as I did when I trained for marathons.)

Your knees/ concrete correlation makes sense but I was one of those high school cross country runners pounding the pavement. That was 45 years ago. I still run on streets and my knees are fine. Granted, I would prefer running on freshly mowed grass but it's not possible where I live so I run where I can.

This is not new. In 1979 mr doctor-- Henry Solomon MD published a book entitled "The Exercise Myth" (http://www.amazon.com/Exercise-Myth-Henry-M-D-Solomon/product-reviews/0553257315/ref=dp_top_cm_cr_acr_txt?ie=UTF8&showViewpoints=1) which reflected a study of @ 1500 men who had died after what he characterized s "violent exercise" ( running races, extremely competitive tennis, etc.) and concluded that after 40 years of age, moderate, not intense, exercise is what is good for health (such as walking at least one mile daily at 3 miles per hour). I followed his advice.a friend who was my age and a much better and more competitive runner ( who was slender and seemed to be in perfect health) died of a heart attack at age 46 training in Central Park NY. Thus far, following my Dr's advice, I have managed to reach 78. Regular exercise is critical to good health, but done with excessive intensity once a man is over 40 is dangerous

Hmmmm, beer= killer, coffee= killer, running= killer, beef= killer. Pretty much everything i like in my life is going to kill me. Good thing I can get all of the above items in the course of one marathon!

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